EP1152685B1 - Deformable fiberscope with a displaceable supplementary device - Google Patents

Abstract

The invention relates to a deformable endoscope that has one or more light/image transmission passages and in which at least one additional instrument is provided, wherein the unit of endoscope and additional instrument has a non-round cross-section along a longitudinal section (insertion section) to be inserted into a human or animal body orifice. The light/image transmission passage or the plurality of light/image transmission passages form-in particular together with at least one work passage-a closed unit (fiberscope part) which can be separated from the additional instrument. The fiberscope part and the additional instrument can be displaced relatively relative to one another along their longitudinal directions. A holding unit is provided for the holding and/or guiding of the fiberscope part and the additional instrument relative to one another.

Description

The invention relates to a deformable endoscope, the one or more Has light / image transmission channels and at least one additional device.

For example, gastroscopes are known that the patient for a Gastric mirroring introduced through the mouth into the esophagus and stomach become. Such gastroscopes have a central working channel, in introduced a small biopsy forceps as an additional device is a to under observation via the light / image transmission channel Take a sample of tissue from the stomach or esophagus.

A disadvantage of these known endoscopes is that they can be used are undesirably limited and their application is a burden for the patient. In particular, for that Introduce known endoscopes to the previous drug attenuation required. An accidental injury to the patient, for example of the pharynx through an orally inserted gastroscope not always be avoided.

US-A-5643175 describes an endoscope according to the Preamble of claim 1.

WO 97/41767 describes a fastening mechanism for fastening of a video endoscope and a surgical instrument.

An endoscope with a biopsy loop is known from US-A-1891054, which is guided within a pipe attached to the side.

It is an object of the invention to provide an endoscope that can be used in a less risk of injury and a more pleasant subjective perception offers a wider range of applications through the patient as known endoscopes.

This object is solved by the features of claim 1.

The invention thus frees itself from the long-established view that endoscopes with a substantially circular cross-section too be provided. The cross section of the insertion section of the invention Endoscope is not rotationally symmetrical, so the endoscope can be better adapted to the intended applications.

The cross section of the insertion section is preferably at the cross section adapted to the body opening into which the endoscope is inserted should and which generally has a non-round cross-section. This allows the use of space, in particular that for insertion of the endoscope's narrowest part of the body. this leads to a more pleasant subjective perception on the part of the patient, and in the patient's body there can be more space for the desired diagnosis or therapy is available. A particular advantage of one Such cross-sectional adjustment is that in many applications for drug absorption, relaxation or anesthesia can be dispensed with, because of the optimized cross-sectional or

Defense reflexes of the patient can be avoided more easily can.

Because the cross section of the endoscope is not round, can also have an advantageous stability of the inserted endoscope against undesirable twists in its longitudinal direction be achieved. With the round cross section of known endoscopes can there is an undesirable twisting in the course of the insertion process of the endoscope. In contrast, if the endoscope - as the invention provides - is asymmetrical in cross section, can The shape of the body opening into which the endoscope is inserted is used to block rotation of the inserted endoscope. This facilitates further insertion of the endoscope and reduces it the risk of injury.

The non-round cross section of the endoscope can be realized in this way be that the additional device - contrary to the construction of known endoscopes - in a non-central location within the cross section of the insertion section is arranged. In particular, one can be used to hold the additional device intended working channel not in a central location, but in terms of the longitudinal axis of the endoscope in a lateral, eccentric arrangement be provided.

The non-round cross section of the endoscope can also be caused by this be achieved that the dimension of the cross section of its insertion section in one direction is significantly larger than the dimension in one orthogonal direction, for example by a factor of at least 1.5. The cross section can be approximately one, for example correspond to an isosceles triangle or a mirror-symmetrical trapezoid, the corners of which are rounded.

In a preferred embodiment, the endoscope is a pharingoesophagogastroscope trained to examine pharynx, The patient's esophagus (esophagus) or stomach by the cross section of the insertion section of the entire endoscope to the cross section is adapted to a nasal passage. Such an endoscope can - in contrast to conventional gastroscopy - the patient via one Nasal passages are inserted into the throat and esophagus.

a) Bei dem nasalen Einführen in den Rachen und in die Speiseröhre kann aufgrund der gleichzeitigen optischen Überwachung über den Licht-/Bildübertragungskanal und aufgrund der Verformbarkeit des Pharingoösophagogastroskops eine Verletzung des Patienten, insbesondere der Rachenschleimhäute, besonders leicht vermieden werden.

b) Im Gegensatz zu dem oralen Einführen eines bekannten Gastroskops erzeugt das nasale Einführen des erfindungsgemäßen Endoskops beim Patienten keinen Abwehrreflexe, insbesondere keine Beißreflexe.

c) Im Unterschied zur herkömmlichen Gastroskopie ist keine lokale medikamentöse Dämpfung des Kehlkopfbereiches erforderlich, so daß der Patient durch die Anwendung des erfindungsgemäßen Endoskops insofern nicht beeinträchtigt wird und nach der Anwendung die ärztliche Praxis oder die Klinik problemlos verlassen kann, ohne auf das Abklingen einer Dämpfungsmaßnahme warten zu müssen.

d) Bei der Anwendung des erfindungsgemäßen des Pharingoösophagogastroskops ist auch ein geringerer Personalaufwand erforderlich, da auf die Hilfestellung durch eine Schwester und einen Springer (zweite Schwester oder Pfleger) verzichtet werden kann und auch kein Anästhesist erforderlich ist. Die Anwendung des Endoskops kann durch einen einzigen Arzt mit seiner Sprechstundenhilfe erfolgen. Ein eigens eingerichteter Endoskopieraum (Operationssaal) ist nicht erforderlich. Die Anwendung des Pharingoösophagogastroskops erfolgt vielmehr auf einem normalen Untersuchungsstuhl in der ärztlichen Praxis. Dies reduziert die Anwendungskosten natürlich in erheblichem Maße.

e) Das erfindungsgemäße Pharingoösophagogastroskop wird aufgrund seines optimierten Querschnitts und seiner somit vergleichsweise geringen Querschnittsfläche vom Patienten als angenehmer empfunden als ein herkömmliches Gastroskop, das üblicherweise einen kreisrunden Querschnitt von ca. 11 mm besitzt und dabei unnötigen Totraum belegt. Zu dieser angenehmeren Wahrnehmung trägt auch bei, daß das Pharingoösophagogastroskop nasal eingeführt wird, so daß der vergleichsweise sensible Mundraum frei von Fremdkörpern bleibt.

f) Das durch einen einzigen Nasengang eingeführte Pharingoösophagogastroskop ermöglicht es dem Patienten, weiterhin sowohl durch den Mund als auch durch die Nase, nämlich durch den nicht belegten Nasengang zu atmen.

g) Das nasal in den Rachenraum eingeführte Pharingoösophagogastroskop kann auf besonders einfache, angenehme und ungefährliche Weise in die Speiseröhre weitergeführt werden, wenn der Patient gleichzeitig eine Flüssigkeit, beispielsweise Wasser, trinkt. Dies ist aufgrund des freien Mundraums problemlos möglich. Der Trinkvorgang kann über den Licht-/Bildübertragungskanal vom Arzt verfolgt werden. Bei einem Schluckvorgang wird das Pharingoösophagogastroskop am Kehlkopf und an der Speiseröhren-Schließmuskulatur vorbei in die Speiseröhre geführt.

h) Das nasal eingeführte Endoskop ermöglicht ein realitätsnahes Studium der Schluckmotorik, der Kontraktionsbewegungen der Speiseröhrenmuskulatur (Peristaltik) und der zugeordneten Schließmuskel (Sphinkter). Diese Untersuchungen können unter Zuhilfenahme des Zusatzgerätes und unter gleichzeitiger Beobachtung über den Licht-/Bildübertragungskanal erfolgen. Solche Funktionsanalysen können sowohl beim Trinken von Flüssigkeit, als auch bei Einnahme von fester Nahrung erfolgen. Es zeigt sich eine geringere Verfälschung des Untersuchungsergebnisses als bei bekannten Gastroskopen, da der Mundbereich von dem nasal eingeführten Pharingoösophagogastroskop nicht blockiert ist und da das Pharingoösophagogastroskop aufgrund seines optimierten Querschnitts eine geringere und somit weniger störende Querschnittsfläche aufweist.

i) Die Anwendung des erfindunsgemäßen Endoskops ist nicht auf Diagnostizierverfahren beschränkt, sondern es eröffnen sich neue Möglichkeiten des Studiums des menschlichen oder tierischen Körpers. Beispielsweise ermöglicht das dem Nasengang angepaßte Pharingoösophagogastroskop die Erforschung des neuen Studiengebietes der sogenannten Somnoskopie:
Da das nasal eingeführte Endoskop dem Patienten weiterhin die Möglichkeit bietet, durch Mund oder Nase zu atmen, und da es vom Patienten auch nicht als besonders unangenehm empfunden wird, kann das Endoskop ohne weiteres über Nacht im Körper des Patienten belassen werden, um über mehrere Stunden andauernde Studien durchzuführen. Beispielsweise kann als Zusatzgerät des erfindungsgemäßen Endoskops eine pH-Meßsonde verwendet werden, die über Nacht an mehreren Stellen entlang der Speiseröhre sowie im Magen den pH-Wert bestimmt, um zu überprüfen, ob bei vergleichsweise ungestörten und stationären Bedingungen sich unerwartete lokale oder zeitliche Anomalien ergeben. Selbstverständlich bleibt bei einer derartigen Anwendung die Möglichkeit einer optischen Kontrolle über den Licht-/Bildübertragungskanal erhalten.

The pharingoesophagogastroscope according to the invention offers the following advantages, among others:

a) With nasal insertion into the throat and into the esophagus, injury to the patient, especially the pharynx mucous membranes, can be avoided particularly easily due to the simultaneous optical monitoring via the light / image transmission channel and the deformability of the pharingo-oesophagogastroscope.

b) In contrast to the oral insertion of a known gastroscope, nasal insertion of the endoscope according to the invention does not produce any defense reflexes, in particular no bite reflexes, in the patient.

c) In contrast to conventional gastroscopy, no local medicinal damping of the larynx area is required, so that the patient is not impaired by the use of the endoscope according to the invention and can leave the medical practice or the clinic without problems after the application, without the decay of a damping measure to have to wait.

d) When using the pharingo-oesophagogastroscope according to the invention, less personnel expenditure is also required, since the help of a sister and a jumper (second sister or carer) can be dispensed with and an anesthetist is also not required. The endoscope can be used by a single doctor with his office help. A specially equipped endoscopy room (operating room) is not required. Rather, the pharingo-oesophagogastroscope is used on a normal examination chair in medical practice. Of course, this significantly reduces the application costs.

e) Due to its optimized cross-section and thus its comparatively small cross-sectional area, the pharingo-oesophagogastroscope according to the invention is perceived by the patient as more pleasant than a conventional gastroscope, which usually has a circular cross-section of approximately 11 mm and thereby occupies unnecessary dead space. The fact that the pharingo-oesophagogastroscope is inserted nasally also contributes to this more pleasant perception, so that the comparatively sensitive mouth remains free of foreign bodies.

f) The pharingo-oesophagogastroscope inserted through a single nasal passage enables the patient to continue breathing through both the mouth and the nose, namely through the unoccupied nasal passage.

g) The nasal pharingo-oesophagogastroscope inserted into the pharynx can be passed into the esophagus in a particularly simple, pleasant and harmless manner if the patient is drinking a liquid, for example water, at the same time. This is easily possible due to the free mouth. The drinking process can be followed by the doctor via the light / image transmission channel. During a swallowing process, the pharingoesophagogastroscope is guided past the larynx and the esophageal sphincter muscles into the esophagus.

h) The nasally inserted endoscope enables a realistic study of the swallowing motor system, the contraction movements of the esophageal muscles (peristalsis) and the associated sphincter (sphincter). These examinations can be carried out with the aid of the additional device and with simultaneous observation via the light / image transmission channel. Such functional analyzes can be carried out both when drinking liquid and when taking solid food. There is less distortion of the examination result than with known gastroscopes, since the mouth area is not blocked by the nasally inserted pharingo-oesophagogastroscope and because the pharingo-oesophagogastroscope has a smaller and therefore less disturbing cross-sectional area due to its optimized cross-section.

i) The application of the endoscope according to the invention is not limited to diagnostic methods, but rather new possibilities of studying the human or animal body open up. For example, the pharingo-oesophagogastroscope adapted to the nasal passage enables research into the new study area of so-called somnoscopy:
Since the nasally inserted endoscope continues to offer the patient the opportunity to breathe through the mouth or nose, and since the patient does not find it particularly uncomfortable, the endoscope can be left in the patient's body overnight for several hours conduct ongoing studies. For example, a pH measuring probe can be used as an additional device of the endoscope according to the invention, which determines the pH overnight at several points along the esophagus and in the stomach in order to check whether unexpected local or temporal anomalies arise under comparatively undisturbed and stationary conditions , Of course, the possibility of optical control over the light / image transmission channel is retained in such an application.

It is in the design of the endoscope as a pharingoesophagogastroscope preferred if the base length of the cross-sectional basic shape, for example the triangular or trapezoidal shape explained, at most 3.5 mm is. Extensive studies have shown that such a Dimension the insertion of the endoscope into a nasal passage is still possible in principle for all patients. It is also preferred if the maximum cross section of the respective additional device is at most approx. 3 mm, in particular a maximum of about 2 mm, so that the additional device along with the rest of the pharingoesophagogastroscope in each patient can be easily guided through a nasal passage. The However, the cross section of the additional device can also be the individual maximum Cross-section of the patient's nasal passage can be adjusted. The typical total length of the pharingoesophagogastroscope is, for example 76 cm.

The invention can also be used in a tracheobronchoscope for examination the trachea and tracheal branches. The above advantages explained come from the Pharingooesophagogastroscope even with such a tracheobronchoscope.

The endoscope according to the invention is made up of several parts, namely from a fibroscope part, which as a closed unit or the light / image transmission channels and preferably one or contains several working channels, as well as one or more Accessories. Since the additional device is placed on the part of the fibroscope this embodiment is also called a "piggyback system" referred to (see Fig. 1). The additional device is preferably located here outside the actual part of the fibroscope.

Depending on the cross-sectional area and shape of the body opening, for example, the nasal passage, the additional device can the fibroscope part or vice versa, the fibroscope part can be placed on the additional device, and the additional device can have a smaller or a larger cross section have than the fibroscope part.

The fibroscope part and the accessory device (s) can be along their respective Longitudinal direction are shifted relative to each other (so-called "shuttle system"). This results in flexible handling and a variable radius of action of the additional device in question.

For example, when using a biopsy forceps as an additional device a displaceability of approx. 5 cm is sufficient, on the one hand, to Avoidance of obstruction to the observation of the insertion process the biopsy forceps with respect to the Retract the part of the fibroscope and, on the other hand, the biopsy forceps extend relative to the stationary part of the fibroscope in the distal direction for the purpose of taking a sample.

A relative displaceability of approx. 35 cm can be particularly useful for Long-term exams prove to be beneficial in those with inpatient Additional device, for example pH measuring probe, only the fibroscope part to be shifted to an optical at a specific pH measuring point Perform observation without doing the continuous measurement interfere with the pH probe or falsify.

To connect the fibroscope part and the additional device (s) to achieve a unit is a holding device on the fibroscope part or provided on the relevant additional device. Preferably can the fibroscope part and the additional device or devices by means of the holding device either fixed to each other or released from each other in this way be that a relative movement between the fibroscope part and additional device is possible.

For example, as a holding device on the operator Doctor's distal end of the endoscope has a loop - for example made of nylon - be provided in which an additional device is held or guided becomes. It is possible to make the sling from a central or a lateral Allow the opening at the distal end of the fibroscope part to protrude.

In particular, a working channel of, for example, can be on the fibroscope part 1 mm can be provided in a grasping forceps of, for example 0.8 mm diameter, which is on a closed loop of a total length of approx. 60 mm. When this noose comes out of the working channel protrudes and there grips an additional device, can be pulled back or inserting the grasping forceps the relevant additional device fixed at the distal end of the fibroscope part via the loop or for one Relative movement are released.

Alternatively, it is possible within a working channel of the fibroscope part to provide a comparatively long loop that is at the distal Grips an additional device at the end of the endoscope and at the proximal end the endoscope operated by the doctor, in particular pulled or released is (see. Fig. 5, 6a, 6b). In this way, the above can be explained Grasping forceps can be dispensed with within the working channel.

In addition, it is applied using the above Principles possible, instead of a loop through one working channel to use guided leash with the accessory concerned is firmly connected. This can prevent the attachment when the sling is released, unintentionally by reaching around the noose leaves.

When forming the endoscope according to the invention with each other separate fibroscope part and additional device, it is further preferred if one or more fastening loops along the insertion section of the fibroscope part are provided as holding devices, in each of which one or more additional devices are guided through loose gripping.

Alternatively or in addition to the use of a sling can be used Inclusion of the additional device a completely or partially the fibroscope part surrounding jacket tube (see. Fig. 7a to 7c) or one on the fibroscope part laterally molded or attached side cover (see Fig. 6a, 6b) be provided. The jacket hose or the side cover can be made of Be plastic and / or elastic. In addition, the Jacket hose or the side cover along the entire insertion section of the endoscope or along only one or more parts be provided.

If the jacket hose or the side cover is only along one Sections of the endoscope extends, the jacket tube or the side cover is designed to be displaceable with respect to the fibroscope part his. This can be used, for example, when using the endoscope Pharingoesophagogastroscope ensures that the jacket tube or the side cover always within the nasal passage and itself is arranged extending to the pharynx, independently on the depth of penetration of the fibroscope part.

For example, when nasally inserting the Pharingoesophagogastroscope the sliding jacket hose at the front end, so The jacket tube can be arranged at the distal end of the fibroscope part from a certain depth of penetration of the fibroscope part its position Maintained in the nasal passage while the fibroscopic part continues is introduced, for example to observe the esophagus. Also if appropriate, follow the fibrosis part to observe the throat the jacket hose retains its position at and is thus again arranged along the distal end of the fibroscope part. Only when the fibroscope part completely out of the nasal passage is pulled out, the sheath tube is removed from the distal Carried end of the fibroscope part.

The particular advantage of this embodiment is that in each an additional device along the above-mentioned conditions easily and painlessly the part of the fibroscope through the jacket tube over the nasal passage can be inserted into the throat. The jacket hose prevents injury to the nasal passage and throat through the attachment, and the distal end of the attachment cannot become unintentionally due to the curvature to be overcome detach from the fibroscope part.

The described displaceability of the jacket hose can be realized by the jacket tube with respect to both the fibroscope part and the auxiliary device can also be moved and as a loose hose section envelops the fibroscope part and, if necessary, the additional device. The side cover can, for example, have a single or double Rail-groove connection slidably connected to the fibroscope part his. In addition, at the proximal end of the jacket tube or Side cover a stop element, for example an annular widening be provided to completely disappear in the nasal passage to prevent. In addition, the endoscope can have a locking device, For example, have a screw through which the jacket hose or the side cover can be temporarily fixed with respect to the fibroscope part.

As a holding device for holding or guiding the fibroscope part and additional device can also have at least one groove and a corresponding one Rail may be provided, each along the entire Insertion section of the endoscope or along one or more parts extend from this (see FIGS. 8, 9). Instead of the groove, one or several holding clips on the fibroscope part or on the additional device be provided (see. Fig. 12, 13).

The holding device provided on the fibroscope part and the additional device is according to the invention by one or more permanent magnets, for example of an iron or nickel alloy, formed with at least one counter element made of a permanent magnetic or magnetic material, such as steel, aluminum or titanium, interact.

In a particularly simple embodiment, this counter element be formed by the additional device or the fibroscope part itself. Moreover it is possible to attach the permanent magnets or the counter elements to provide several sections of the fibroscope part or the additional device. To ensure direct contact of the magnetic materials used to avoid, and to avoid both that between the attachment and the fibroscope part reducing static friction as well as sliding friction, can the permanent magnet, the counter element or both one Have a plastic cover.

Furthermore, on the one hand and on the other hand, a driver element and a hooking device on the additional device are provided, or vice versa. This makes it possible hooked additional device into the body opening using the fibroscope part introduce, especially to pull. Then the additional device can be released to make movements independent of the position of the fibroscope part and conduct investigations.

The driver element and the hooking device are preferably each arranged on the distal surface of the fibroscope part or the additional device. The hooking device can for example by a laterally protruding Undercut approach and the driver element through a laterally protruding, in the undercut approach if necessary engaging button neck be formed. If the driver element and the hooking device is flattened towards the proximal end of the endoscope are formed, pulling out the fibroscope part or of the additional device can be carried out particularly easily and safely from the body opening.

Of course, it is also possible to have several on a single endoscope to combine the holding devices mentioned.

Each of the above-described embodiments of the invention Endoscope can have at least one working channel into which one Aids or an additional device can be introduced or the Performing rinses or for sucking off body fluids can serve.

As the additional device mentioned in connection with the invention, For example, a biopsy forceps, an aspirator / injector probe, a pH measuring probe, for example a manometry probe for examining esophageal peristalsis, a Bilitec measuring probe for Measurement of bilirubin content, a laser probe, or other surgical Instruments for therapeutic measures may be provided. Moreover can due to the optimized use of space of the invention Endoscope also several additional devices can be provided, for example a biopsy forceps and a pH probe.

Of course, for the light / image transmission channels the known division into a light transmission channel on the one hand and an image transmission channel may be provided on the other hand. For example one or more light guides can form a light transmission channel. The image transmission channel can also be through optical fibers and associated Optics are formed, or it can be an opto-electronic Image converter at the distal end of the endoscope and corresponding electrical Have supply and transmission lines.

Furthermore, the endoscope according to the invention can have one or more Bowden cable systems for active lateral alignment. In this case the swivel direction can be with the direction of the larger or the smaller Cross-sectional dimensions of the endoscope coincide. At a It is the nasal endoscope that needs to be passed the change of direction required for the pharynx is an advantage, if the endoscope is at least in the direction of the larger cross-sectional dimension the endoscope is actively pivotable.

The endoscope according to the invention with its special advantages can are used in many areas of endoscopy, for example in bronchoscopy. There is an advantageous application also in the flushing of body cavities, for example from Eustachian Tube or maxillary sinus. The invention also finds application in surgery, especially for performing sterile work with With the help of additional devices with simultaneous optical observation.

Fig. 1, 8, 10, 12, 14 und 16

schematische Seitenansichten jeweils eines Endoskops,

Fig. 2, 6b, 9, 11a, 11b und 13

jeweils einen Schnitt entlang der Ebene II-II gemäß Fig. 1, der Ebene VI-VI gemäß Fig. 6a, der Ebene IX-IX gemäß Fig. 8, der Ebene XI-XI gemäß Fig. 10, der Ebene XI-XI gemäß Fig. 10, bzw. entlang der Ebene XIII-XIII gemäß Fig. 12,

Fig. 3 und 3b

Detailansichten des Bereichs III gemäß Fig. 1,

Fig. 4

einen schematischen Frontalschnitt durch eine menschliche Nase,

Fig. 5 und 6a

den Fig. 3a und 3b entsprechende Detailansichten jeweils eines weiteren Endoskops,

Fig. 7a bis 7c

der Fig. 2 entsprechende Schnittansichten weiterer Endoskope,

Fig. 15a, 15b, 15c und 15d

jeweils einen Schnitt entlang der Ebene XV-XV gemäß Fig. 14 für verschiedene Ausführungsformen,

Fig. 17

eine Detailansicht des Bereichs XVII gemäß Fig. 16, und

Fig. 18

die Unterseite des distalen Endes des Zusatzgeräts gemäß Fig. 16 in einer Detailansicht.

Further preferred embodiments of the endoscope emerge from the subclaims. The invention is described below by way of example with reference to the drawings; in these show:

1, 8, 10, 12, 14 and 16

schematic side views of one endoscope,

2, 6b, 9, 11a, 11b and 13

1, the plane VI-VI according to FIG. 6a, the plane IX-IX according to FIG. 8, the plane XI-XI according to FIG. 10, the plane XI-XI according to 10, or along the plane XIII-XIII according to FIG. 12,

3 and 3b

Detailed views of area III according to FIG. 1,

Fig. 4

a schematic frontal section through a human nose,

5 and 6a

3a and 3b corresponding detail views of a further endoscope,

7a to 7c

2 corresponding sectional views of further endoscopes,

15a, 15b, 15c and 15d

in each case a section along the plane XV-XV according to FIG. 14 for different embodiments,

Fig. 17

a detailed view of the area XVII of FIG. 16, and

Fig. 18

the underside of the distal end of the additional device according to FIG. 16 in a detailed view.

Only FIGS. 14, 15a, 15b, 15c and 15d show embodiments the invention.

1 shows a side view of a pharingoesophagogastroscope. This has a fibroscope 11 with an elongated one Insertion section 13 and a proximal operating part 15. On the Operating part 15 are the open ends of two light transmission channels 17 and an optical image transmission channel 19 and the operator side Ends of a grasping forceps 21 and a Bowden cable 23 shown respective course within the insertion section 13 of the fibroscope 11 is not shown in Fig. 1.

Furthermore, the endoscope according to FIG. 1 has an additional device 25 in the form of a elongated biopsy forceps. This additional device 25 is at the distal end the endoscope via a loop 27 and close to the operating part 15 connected to the fibroscope 11 by means of a fastening loop 29.

2 shows a section through the insertion section 13 of the endoscope 1 that the fibroscope 11 is a flexible jacket tube 31 as the outer shell and a central working channel 33, in which the grasping forceps 21 is guided. The Bowden cable 23 is not shown here.

3a and 3b each show detailed views of area III in accordance with Fig. 1, so the distal end of the endoscope. The one in working channel 33 guided grasping forceps 21 holds the loop 27. This protrudes to make it possible a relative movement of the fibroscope 11 and biopsy forceps 25 from the Fibroscope 11 and loosely grips the biopsy forceps 25 (Fig. 3a). By pulling back the gripping forceps 21 relative to the fibroscope 11 the loop 27 is drawn deeper into the working channel 33, so that the free Length of the loop 27 is reduced and the biopsy forceps 25 at the distal End of the fibroscope 11 is fixed (Fig. 3b). Instead of the grasping forceps 21 Another type of loop holder can of course also be provided his.

The endoscope formed by the fibroscope 11 and the additional device 25 1 to 3b a patient can pass through a nasal passage into the Pharynx and subsequently inserted into the esophagus and stomach become. This type of application is explained below with reference to FIG. 4. This shows a frontal section of a nose with a nasal septum 35, two middle shells 37 and two lower shells 39. Limit the lower turbinates 39 and the nasal septum 35 each a lower nasal passage 41. In such a lower nasal passage 41, preferably in the larger one, an endoscope can be inserted become.

Due to the ultimately elongated cross-section of the nasal passages 41 can an endoscope with a comparatively large cross section 43 is introduced, if this cross section 43 - as shown in FIG. 4 - is a non-circular, but has the shape of the body opening 41 in question. With in other words, with the endoscope shaped in this way the improved use of space more or larger additional devices or Light / image transmission channels are inserted through the nasal passage than with a conventional round cross section fibroscope.

The overall cross section of the endoscope according to FIG. 1 is accordingly not circular, but - as for the unit consisting of fibroscope 11 and additional device 25 from FIG. 2 - the cross section 43 shown in FIG. 4 modeled. The adapted cross-section of the endoscope gives it also stability with regard to an unwanted rotation about its Longitudinal axis. This is especially true with an active curvature and Alignment of the endoscope using a Bowden cable is an advantage.

1 - as for the cross section 43 in Fig. 4 shown - introduced via the nasal passage 41, so the flexible Accessory 25 over the loop 27 from the distal end of the fibroscope 11 out, by appropriate actuation of the Bowden cable 23. At the same time in a known manner, the relevant Body region illuminated via the light transmission channels 17 and over the image transmission channel 19 and corresponding optics and video technology to be watched.

1 it should be noted that this is also via the gripping pliers 21 guided in the central working channel 33 take a sample is possible. However, the working channel 33 of the fibroscope has 11 typically an inner diameter of only 1 mm. The grasping forceps 21 of accordingly less than 1 mm outside diameter can only remove mucosal tissue. On the other hand, the Biopsy forceps 25 of the endoscope according to the invention due to its larger size Diameter, samples can also be taken from deeper tissue layers.

5 to 18 are further exemplary embodiments below described by endoscopes, being the same or same elements as in Figs. 1 to 3b each with the same reference numerals Marked are.

5 differs from the endoscope 1 in that the loop 27 is not of its own Grasping forceps 21 is held, but ultimately single-stranded through the working channel 33 is guided to an operating part, not shown. The Working channel 33 does not open here on the distal end face, but on a side portion of the distal end of the fibroscope 11.

In the exemplary embodiment according to FIG. 6a there is also a single loop 27 provided without grasping forceps. The loop 27 is - in contrast to Fig. 5 - not in a central working channel, but within one the fibroscope 11 is formed on the side cover 45. This principle is also illustrated in the frontal sectional view according to FIG. 6b. The beveled Opening of the side sheath 45 at the distal end of the fibroscope 11 can be closed with an end piece ("dummy") if the additional device 25 and thus the loop 27 are not required.

7a shows a further endoscope in a cross-sectional view its introductory section. Here too is a fibroscope 11 and an additional device 25 as essentially separate components provided that via an elastic common jacket hose 31st are interconnected. As can be seen from Fig. 7b, this pulls Jacket hose 31 together with the removal of the additional device 25 to as To serve the outer shell of the fibroscope 11 only.

In Fig. 7c it is shown that the jacket tube 31 - similar to the side cover 45 according to FIGS. 6a and 6b - also only on part of the circumference of the Fibroscope 11 can be provided to add an additional device if necessary take.

8 there is a fibroscope 11 and an additional device 25 in the form of an aspirator / injector probe as independent of each other Units formed only by a common holding device are interconnected. Like the sectional view according to FIG. 9 shows this holding device by means of an attachment 25 molded guide approach in the form of a rail 47 and on the part of Fibroscope 11 formed by a corresponding groove 49. The groove 49 extends clearly along the longitudinal direction of the fibroscope 11 greater length than the length of the rail 47, so that a longitudinal displacement of fibroscope 11 and additional device 25 relative to one another only is possible within predetermined limits.

This endoscope can be used for additional stabilization of the fibroscope 11 and auxiliary device 25 a stabilization device outside of Body, in particular near the operating part 15 may be provided. This Stabilizing device can also by a groove-rail system be formed and is preferably attached to the fibroscope 11 and / or the additional device 25 can be clipped on.

10 also shows an endoscope that differs from the exemplary embodiments 1 to 9 as a single closed unit is formed, and its insertion section 13 according to the invention one does not have a circular cross-section. There is an additional device for this endoscope 25 - for example a biopsy forceps - provided, which in A comparison to additional devices of corresponding conventional endoscopes can have significantly larger cross-sectional diameter. This is possible because the non-rotationally symmetrical cross section of the endoscope a more flexible arrangement of the auxiliary device 25, the light / image transmission channels 17, 19 and the Bowden cable 23 within the insertion section 13 allowed, the additional device 25 is not necessarily more central Place is arranged.

The endoscope according to FIG. 10 can, for example, be the one shown in FIG. 11a Have cross-section. Here form a light transmission channel 17 Image transmission channel 19 and one guided within a working channel 33 Additional device 25 a unit surrounded by a jacket hose 31, which is an isosceles triangle or trapezoid with rounded Corners are alike.

The cross-section likewise possible for the endoscope according to FIG. 10 according to FIG 11b has a comparable, essentially triangular shape. Here, the additional device 25 is firmly integrated into the endoscope, which nevertheless - as can be seen in FIG. 10 - deformed and laterally aligned can be. In addition, according to the specific embodiment 11b shows two light transmission channels 17, one image transmission channel 19 and a separate flushing channel 51 are provided.

Fig. 12 again shows an embodiment with one of the fibroscopic part 11 independent additional device 25. The additional device 25 has similar to the rail-groove connection according to FIGS. 8 and 9, via its A number of retaining clips 53 distributed at equal intervals in length each protruding laterally from the auxiliary device 25 and one along the Grip around the fibroscope part 11 formed rail 47. Like the cross-sectional view 13, the retaining clips 53 have a C-shaped and the rail 47 a T-shaped cross section.

Along a proximal section of the fibroscope part 11 is on this a side cover 45 is formed, which the attachment of the additional device 25 on the rail 47 of the fibroscopic part 11 facilitates and the insertion of the Fibroscopic part 11 with attached accessory 25 in the relevant body opening, especially supports the nasal passage. The so put on Additional device 25 can be arbitrarily and without limitation along the fibroscope part 11 can be moved. In particular, the auxiliary device 25 with the fibroscope part 11 already inserted into the body opening be, the fibroscopic part 11 for the required guidance provides.

14 is a biopsy forceps as an additional device 25 made of a magnetizable metal. As from the cross-sectional view 15a can be seen, is in the fibroscope part 11 Permanent magnet 55 integrated, which magnetically attract the additional device 25 can. Because of this magnetic interaction the additional device 25 is guided along the fibroscope part 11.

The auxiliary device is along a proximal part of the fibroscope part 11 25 for additional guidance and stabilization by a side cover 45 guided. The permanent magnet is along a distal part of the fibroscope part 11 55 provided only in sections, so that the relevant Sections an intended release of the distal end of the Additional device 25 of the fibroscope part 11 is possible.

By surrounding the fibroscope part 11 and into the side cover 45 passing jacket hose 31 also as a cover 57 of the permanent magnet 55 is used, the friction between the fibroscope part 11 and the auxiliary device 25 is reduced and the relative mobility is increased.

15b shows the cross-sectional view of a modified embodiment, in which the side cover 45 via a double rail-groove connection is attached to the jacket hose 31 and thus along the entire fibroscopic part 11 can be moved. This allows the Side cover 45 regardless of the insertion depth of the fibroscopic part 11 always be left in the patient's nasal passage 41 (Fig. 4) to the Pain and injury-free tracking of the auxiliary device 25 to facilitate. The rails of the side cover 45 which are T-shaped in cross section extend over the entire length of the side cover 45. The corresponding Grooves on the fibroscope part 11 run along the entire insertion section 13 to just before the distal end of the fibroscope part 11.

15c shows a further embodiment in which the side cover 45 is shown the jacket hose 31 is formed. In contrast to the embodiment 15a is the unit of side cover 45 and jacket hose 31 here loosely covered over the fibroscope part 11, so that this Unit moved relative to both the fibroscope part 11 and the additional device can be. A stopper, not shown, at the distal end of the Fibroscopic part 11 can unintentionally detach from the fibroscopic part 11 prevent.

FIG. 15d shows one corresponding to the embodiment according to FIG. 15b Another example of a rail-groove connection of a jacket hose 31 with a separate side cover 45, which is only along a section of the fibroscope part 11 is provided and shifted relative thereto can be. In this example there is a splint on the part of the fibroscope part 11 provided while a corresponding groove on the side cover 45 is arranged. This reverse arrangement of rail and Groove can reduce the risk of injury in some applications.

15d is also the rail by the permanent magnet 55 itself, which is rounded in cross section educated. This results in a volume reduction within the fibroscope part 11 achieved, and the additional device 25 can in favor of a higher magnetic attraction at least outside the side shell 45 immediately rest on the permanent magnet 55.

Finally, it is alternative in the embodiment according to FIG. 15d possible that the side cover 45 engages around the single rail 55 like a clamp without cover web 57, so that the additional device 25 also within the side cover 45 can rest directly on the rail 55.

16 and 17 show an endoscope with a manometry probe as an additional device 25. This is at the distal end with its distal end of the fibroscope part 11 hooked. For this is on the additional device 25 Hooking device 59 in the form of a laterally projecting undercut attachment provided that a driver element 61 of the fibroscope part 11 engages behind and partially encompasses. The driver element 61 is by a button extension projecting laterally from the fibroscope part 11 formed in a along the longitudinal direction of the auxiliary device 25 introduced at the undercut 59 formed longitudinal slot 63 is. The position of the driver element 61 hooked in in this way starts out 18 shows the underside of the additional device 25 in a detailed view shows.

The additional device 25 hooked in this way can be used together with the fibroscope part 11 are inserted into the body opening. If afterwards the additional device 25 is pushed over the fibroscope part 11, that leaves Driver element 61, the hooking device 59 Additional device 25 act independently of the fibroscope part 11, and that additional device 25 can in particular be independent of the fibroscope part 11 of the body opening can be removed again.

LIST OF REFERENCE NUMBERS

11

fiberscope

13

insertion

15

operation part

17

Light transmission channel

19

Image transmission channel

21

forceps

23

Bowden

25

attachment

27

loop

29

attachment loop

31

jacket hose

33

working channel

35

Nasal septum

37

medium shell

39

lower shell

41

lower nasal passage

43

cross-section

45

side shell

47

rail

49

groove

51

irrigation channel

53

retaining clip

55

permanent magnet

57

cover

59

hooking

61

dogging

63

longitudinal slot

Claims (16)

1. A deformable endoscope that has one or more light/image transmission passages (17, 19) and at least one additional instrument (25), wherein the light/transmission passage or the plurality of light/image transmission passages (17, 19) - in particular together with at least one work channel (33) - form a closed fibroscope part (11);
   wherein the fiboroscope part (11) can be separated from the additional instrument (25);
   wherein a holding device is provided for the holding/and or guiding of the fibroscope part (11) and the additional instrument (25) relative to one another;
   wherein at least one permanent magnet (55) or at least one counter-element (25) made of permanently magnetic or magnetic material are provided as a holding device at the fibroscope part (11), on the one hand, and at the additional instrument (25) on the other hand, or vice versa,
   characterised in that the unit of endoscope (11) and additional instrument (25) has a non-round cross-section (43) along a longitudinal section (13) (insertion section) to be introduced into a human or animal body orifice (41); and
   in that the fibroscope part (11) and the additional instrument (25) can be displaced relative to one another along their longitudinal direction.
2. An endoscope in accordance with claim 1, characterised in that the additional instrument (25) can be alternatively fixed to the fibroscope part (11) by means of the holding device or can be released from the fibroscope part (11) to allow a relative movement along the longitudinal direction of the additional instrument (25) and of the fibroscope part (11).
3. An endoscope in accordance with any one of the preceding claims, characterised in that the holding device has at the distal end of the fibroscope part (11), for the acceptance of the additional instrument (25), a loop (27) to engage around the additional instrument (25) and whose free length can preferably be actively modified.
4. An endoscope in accordance with claim 3, characterised in that the loop (27) is held by fixation forceps (21) which are guided in a work passage (33, 45) provided at the fibroscope part (11); or in that the loop (27) projects out of a work channel (33, 45) - at both the distal and proximal ends - provided at the fibroscope part (11).
5. An endoscope in accordance with any of the preceding claims, characterised in that a groove (49) or a holding clamp (53) and a corresponding rail (47) or corresponding rail segments are provided as a holding device at the fibroscope part (11), on the one hand, and at the additional instrument (25), on the other hand, or vice versa.
6. An endoscope in accordance with any one of the preceding claims, characterised in that the counter-element is an integral part of the additional instrument (25) or of the fibroscope part (11); and/or in that the permanent magnet (55) is provided at a plurality of sections of the fibroscope part (11) or of the additional instrument; and/in or that the permanent magnet (55) and/or the counter-element have a covering (57) of plastic.
7. An endoscope in accordance with any one of the preceding claims, characterised in that a catch element (61) and a hook device (59) are provided as the holding device at the fibroscope part (11), on the one hand and at the additional instrument (25) on the other hand, or vice versa.
8. An endoscope in accordance with claim 7, characterised in that the catch element (61) and/or the hook device (59) are each provided at the distal end of the fibroscope part (11) or of the additional instrument (25) respectively; and/or in that the catch element (61) is formed by a laterally projecting button lug and the hook device (59) by a laterally projecting undercutting lug; and/or in that the catch element (61) and/or the hook device (59) are formed in a manner flattened towards the proximal end of the endoscope.
9. An endoscope in accordance with any one of the preceding claims, characterised in that at least one fastening hoop (29) is provided along the insertion section (13) of the endoscope and spaced apart-from its distal end for the guidance of the additional instrument (25).
10. An endoscope in accordance with any one of the preceding claims, characterised in that a jacket hose (31) or a side cover (45) is provided at the fibroscope part (11) as a holding device for the receiving of the additional instrument (25), said jacket hose (31) or side cover (45) extending along the whole insertion section or along a part of the insertion section (13) of the endoscope.
11. An endoscope in accordance with any one of the previous claims, characterised in that the jacket hose (31) surrounds both the fibroscope part (11) and the additional instrument (25) and/or is elastically formed with respect to its diameter; and/or in that the jacket hose (31) or the side cover (45) is formed displaceably with respect to the fibroscope part (11), in particular due to a rail-groove connection (Fig. 15b).
12. An endoscope in accordance with any one of the preceding claims, characterised in that the cross-section (43) of the insertion section (13) is matched to the body orifice (41); and/or in that the endoscope is formed as a pharingo-oesophago-gastroscope for the examination of the pharynx, oesophagus and/or stomach, wherein the cross-section (43) of the insertion section (13) is matched to the cross-section of a human meatus of the nose (41).
13. An endoscope in accordance with any one of the preceding claims, characterised in that the cross-section dimension of the insertion section (13) is larger in one direction, in particular larger at least by a factor of 1.5, than in a direction orthogonal thereto; and/or in that the cross-section (43) of the insertion section (13) corresponds to an isosceles triangle or to a mirror-symmetrical trapezium, each with rounded corners and preferably with a base length of at most approximately 3.5 mm.
14. An endoscope in accordance with any one of the preceding claims, characterised in that the additional instrument (25) is formed by biopsy forceps, an aspirator/injector probe, a pH probe, a pressure measuring instrument and/or a Bilitec measuring probe; and/or in that the maximum cross-section dimension of the additional instrument (25) amounts to at most approximately 3 mm and preferably at most approximately 2 mm.
15. An endoscope in accordance with any one of the preceding claims, characterised in that the additional instrument (25) is provided laterally spaced with respect to the centre of the cross-section (43) of the insertion section (13); and/or in that the fibroscope part (11) and the additional instrument (25) are displaceable relative to-one another by a length of up to approximately 5 cm or of up to approximately 35 cm along their longitudinal directions.
16. An endoscope in accordance with any one of the preceding claims, characterised in that the endoscope has a Bowden cable (23) by which the endoscope can be actively pivoted in the direction of its larger cross-sectional dimension; and/or in that at least one separate light transmission passage (17) and at least one separate image transmission passage (19) are provided as the light/image transmission passages.

Images